Megastudies improve the impact of applied behavioural science

Measuring and shaping the nutritional environment via food sales logs: case studies of campus-wide food choice and a call to action

Although diets influence health and the environment, measuring and changing nutrition is challenging. Traditional measurement methods face challenges, and designing and conducting behavior-changing interventions is conceptually and logistically complicated. Situated local communities such as university campuses offer unique opportunities to shape the nutritional environment and promote health and sustainability. The present study investigates how passively sensed food purchase logs typically collected as part of regular business operations can be used to monitor and measure on-campus food consumption and understand food choice determinants. First, based on 38 million sales logs collected on a large university campus over eight years, we perform statistical analyses to quantify spatio-temporal determinants of food choice and characterize harmful patterns in dietary behaviors, in a case study of food purchasing at EPFL campus. We identify spatial proximity, food item pairing, and academic schedules (yearly and daily) as important determinants driving the on-campus food choice. The case studies demonstrate the potential of food sales logs for measuring nutrition and highlight the breadth and depth of future possibilities to study individual food-choice determinants. We describe how these insights provide an opportunity for stakeholders, such as campus offices responsible for managing food services, to shape the nutritional environment and improve health and sustainability by designing policies and behavioral interventions. Finally, based on the insights derived through the case study of food purchases at EPFL campus, we identify five future opportunities and offer a call to action for the nutrition research community to contribute to ensuring the health and sustainability of on-campus populations-the very communities to which many researchers belong.

What drives disagreement about moral hypocrisy? Perceived comparability and how people exploit it to criticize enemies and defend allies

Charges of hypocrisy are usually thought to be to be damning. Yet when a hypocrisy charge is made, there often remains disagreement about whether or not its target really is a hypocrite. Why? Three pre-registered experiments (N = 2599) conceptualize and test the role of perceived comparability in evaluating hypocrisy. Calling someone a hypocrite typically entails invoking a comparison-one meant to highlight internal contradiction and cast moral character into question. Yet there is ambiguity about which sorts of comparisons are valid in the first place. We argue that disagreements about moral hypocrisy often boil down to disagreements about comparability. Although the comparability of two situations should not depend on whose behavior is being scrutinized, observers shift comparability judgments in line with social motives to criticize or defend. In short, we identify a cognitive factor that can help to explain why, for similar patterns of behavior, people see hypocrisy in their enemies but consistency in themselves and their allies.

What Happens When Payments End? Fostering Long-Term Behavior Change With Financial Incentives

Financial incentives are widely used to get people to adopt desirable behaviors. Many small landholders in developing countries, for example, receive multiyear payments to engage in conservation behaviors, and the hope is that they will continue to engage in these behaviors after the program ends. Although effective in the short term, financial incentives rarely lead to long-term behavior change because program participants tend to revert to their initial behaviors soon after the payments stop. In this article, we propose that four psychological constructs can be leveraged to increase the long-term effectiveness of financial-incentive programs: motivation, habit formation, social norms, and recursive processes. We review successful and unsuccessful behavior-change initiatives involving financial incentives in several domains: public health, education, sustainability, and conservation. We make concrete recommendations on how to implement the four above-mentioned constructs in field settings. Finally, we identify unresolved issues that future research might want to address to advance knowledge, promote theory development, and understand the psychological mechanisms that can be used to improve the effectiveness of incentive programs in the real world.

Combining anchoring with financial incentives to increase physical activity: a randomized controlled trial among college students

The purpose of this study was to: (1) compare the relative efficacy of different combinations of three behavioral intervention strategies (i.e., personalized reminders, financial incentives, and anchoring) for establishing physical activity habits using an mHealth app and (2) to examine the effects of these different combined interventions on intrinsic motivation for physical activity and daily walking habit strength. A four-arm randomized controlled trial was conducted in a sample of college students (N = 161) who had a self-reported personal wellness goal of increasing their physical activity. Receiving cue-contingent financial incentives (i.e., incentives conditional on performing physical activity within ± one hour of a prespecified physical activity cue) combined with anchoring resulted in the highest daily step counts and greatest odds of temporally consistent walking during both the four-week intervention and the full eight-week study period. Cue-contingent financial incentives were also more successful at increasing physical activity and maintaining these effects post-intervention than traditional non-cue-contingent incentives. There were no differences in intrinsic motivation or habit strength between study groups at any time point. Financial incentives, particularly cue-contingent incentives, can be effectively used to support the anchoring intervention strategy for establishing physical activity habits. Moreover, mHealth apps are a feasible method for delivering the combined intervention technique of financial incentives with anchoring.

Field testing the transferability of behavioural science knowledge on promoting vaccinations

As behavioural science is increasingly adopted by organizations, there is a growing need to assess the robustness and transferability of empirical findings. Here, we investigate the transferability of insights from various sources of behavioural science knowledge to field settings. Across three pre-registered randomized controlled trials (RCTs, N = 314,824) involving a critical policy domain-COVID-19 booster uptake-we field tested text-based interventions that either increased vaccinations in prior field work (RCT1, NCT05586204), elevated vaccination intentions in an online study (RCT2, NCT05586178) or were favoured by scientists and non-experts (RCT3, NCT05586165). Despite repeated exposure to COVID-19 vaccination messaging in our population, reminders and psychological ownership language increased booster uptake, replicating prior findings. However, strategies deemed effective by prediction or intention surveys, such as encouraging the bundling of COVID-19 boosters and flu shots or addressing misconceptions, yielded no detectable benefits over simple reminders. These findings underscore the importance of testing interventions' transferability to real-world settings.

Increasing Postpartum Primary Care Engagement through Default Scheduling and Tailored Messaging: A Randomized Clinical Trial

Importance

Over 30% of pregnant people have at least one chronic medical condition, and nearly 20% develop gestational diabetes or pregnancy-related hypertension, increasing the risk of future chronic disease. While these individuals are often monitored closely during pregnancy, they face significant barriers when transitioning to primary care following delivery, due in part to a lack of health care support for this transition.

Objective

To evaluate the impact of an intervention designed to improve postpartum primary care engagement by reducing patient administrative burden and information gaps.

Design

Individual-level randomized controlled trial conducted from November 3, 2022 to October 11, 2023.

Setting

One hospital-based and five community-based outpatient obstetric clinics affiliated with a large academic medical center.

Participants

Participants included English- and Spanish-speaking pregnant or recently postpartum adults with obesity, anxiety, depression, diabetes mellitus, chronic hypertension, gestational diabetes, or pregnancy-related hypertension, and a primary care practitioner (PCP) listed in their electronic health record (EHR).

Intervention

A behavioral economics-informed intervention bundle, including default scheduling of postpartum PCP appointments and tailored messages.

Main Outcome

Completion of a PCP visit for routine or chronic condition care within 4 months of delivery.

Results

360 patients were randomized (Control: N=176, Intervention: N=184). Individuals had mean (SD) age 34.1 (4.9) years and median gestational age of 36.3 weeks (interquartile range (IQR) 34.0-38.6 weeks) at enrollment. The distribution of self-reported races was 7.4% Asian, 6.8% Black, 15.0% multiple races or "Other," and 68.6% White. Most (75.8%) participants had anxiety or depression, 15.9% had a chronic or pregnancy-related hypertensive disorder, 19.8% had pre-existing or gestational diabetes, and 40.4% had a pre-pregnancy BMI ≥30 kg/m2. Medicaid was the primary payer for 21.9% of patients. PCP visit completion within 4 months occurred in 22.0% in the control group and 40.0% in the intervention group. In regression models accounting for randomization strata, the intervention increased PCP visit completion by 18.7 percentage points (95%CI 10.7-29.1). Intervention participants also had fewer postpartum readmissions (1.7 vs. 5.8%) and increased receipt of the following services by a PCP: blood pressure screening (42.8 vs. 28.3%), weight assessment (42.8 vs. 27.7%), and depression screening (32.8 vs. 16.8%).

Conclusions and Relevance

In this randomized trial of pregnant individuals with or at risk for chronic health conditions, default PCP visit scheduling, tailored messages, and reminders substantially improved postpartum primary care engagement. The current lack of support for postpartum transitions to primary care is a missed opportunity to improve recently pregnant individual's short- and long-term health. Reducing patient administrative burdens may represent relatively low-resource, high-impact approaches to improving postpartum health and wellbeing.

Trial Registration

NCT05543265.

Stress reduction experiments in daily life: Scaling from the lab to the world

Paced breathing-longer exhalation than inhalation-can show short-term improvement of physiologic responses and affective well-being, though most studies have relied on narrow sample demographics, small samples, and control conditions that fail to address expectancy effects. We addressed these limitations through an app-based experiment where participants were randomly assigned to paced breathing or sham control (hand closure) conditions. We first validated the conditions in an online sample (N = 201; Study 1) and in a lab environment (N = 72; Study 2). In the primary app-based experiment, participants (N = 3,277; Study 3) completed 3 days of baseline assessments that included three check-ins each day in which we obtained heart rate and blood pressure responses using an optic sensor and assessed current stress and emotions. Participants were then randomly assigned to either the paced breathing or hand closure condition for the next 6 days. Relative to baseline days, both conditions were associated with increased positive emotions and perceived coping, and reduced blood pressure. Moreover, the increase in positive emotions and perceived coping was not evident among a comparison sample (N = 2,600) who completed check-ins but did not participate in either of the paced breathing or sham-control conditions. However, their blood pressure declined over time, suggesting that the continual monitoring of one's blood pressure may result in detectable decreases. Our results highlight the importance of designing experiments with appropriately matched control conditions and suggest that changes associated with techniques like paced breathing, in part, may stem from positive incidental features of the technique. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The motivating effect of monetary over psychological incentives is stronger in WEIRD cultures

Motivating effortful behaviour is a problem employers, governments and nonprofits face globally. However, most studies on motivation are done in Western, educated, industrialized, rich and democratic (WEIRD) cultures. We compared how hard people in six countries worked in response to monetary incentives versus psychological motivators, such as competing with or helping others. The advantage money had over psychological interventions was larger in the United States and the United Kingdom than in China, India, Mexico and South Africa (N = 8,133). In our last study, we randomly assigned cultural frames through language in bilingual Facebook users in India (N = 2,065). Money increased effort over a psychological treatment by 27% in Hindi and 52% in English. These findings contradict the standard economic intuition that people from poorer countries should be more driven by money. Instead, they suggest that the market mentality of exchanging time and effort for material benefits is most prominent in WEIRD cultures.

Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials

OBJECTIVE

To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions.

DESIGN

Systematic review and network meta-analysis.

METHODS

Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool.

DATA SOURCES

Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression.

RESULTS

218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges' g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments.

CONCLUSIONS

Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018118040.

Addressing climate change with behavioral science: A global intervention tournament in 63 countries

Effectively reducing climate change requires marked, global behavior change. However, it is unclear which strategies are most likely to motivate people to change their climate beliefs and behaviors. Here, we tested 11 expert-crowdsourced interventions on four climate mitigation outcomes: beliefs, policy support, information sharing intention, and an effortful tree-planting behavioral task. Across 59,440 participants from 63 countries, the interventions' effectiveness was small, largely limited to nonclimate skeptics, and differed across outcomes: Beliefs were strengthened mostly by decreasing psychological distance (by 2.3%), policy support by writing a letter to a future-generation member (2.6%), information sharing by negative emotion induction (12.1%), and no intervention increased the more effortful behavior-several interventions even reduced tree planting. Last, the effects of each intervention differed depending on people's initial climate beliefs. These findings suggest that the impact of behavioral climate interventions varies across audiences and target behaviors.

Academics are more specific, and practitioners more sensitive, in forecasting interventions to strengthen democratic attitudes

Concern over democratic erosion has led to a proliferation of proposed interventions to strengthen democratic attitudes in the United States. Resource constraints, however, prevent implementing all proposed interventions. One approach to identify promising interventions entails leveraging domain experts, who have knowledge regarding a given field, to forecast the effectiveness of candidate interventions. We recruit experts who develop general knowledge about a social problem (academics), experts who directly intervene on the problem (practitioners), and nonexperts from the public to forecast the effectiveness of interventions to reduce partisan animosity, support for undemocratic practices, and support for partisan violence. Comparing 14,076 forecasts submitted by 1,181 forecasters against the results of a megaexperiment (n = 32,059) that tested 75 hypothesized effects of interventions, we find that both types of experts outperformed members of the public, though experts differed in how they were accurate. While academics' predictions were more specific (i.e., they identified a larger proportion of ineffective interventions and had fewer false-positive forecasts), practitioners' predictions were more sensitive (i.e., they identified a larger proportion of effective interventions and had fewer false-negative forecasts). Consistent with this, practitioners were better at predicting best-performing interventions, while academics were superior in predicting which interventions performed worst. Our paper highlights the importance of differentiating types of experts and types of accuracy. We conclude by discussing factors that affect whether sensitive or specific forecasters are preferable, such as the relative cost of false positives and negatives and the expected rate of intervention success.

A megastudy on the predictability of personal information from facial images: Disentangling demographic and non-demographic signals

While prior research has shown that facial images signal personal information, publications in this field tend to assess the predictability of a single variable or a small set of variables at a time, which is problematic. Reported prediction quality is hard to compare and generalize across studies due to different study conditions. Another issue is selection bias: researchers may choose to study variables intuitively expected to be predictable and underreport unpredictable variables (the 'file drawer' problem). Policy makers thus have an incomplete picture for a risk-benefit analysis of facial analysis technology. To address these limitations, we perform a megastudy-a survey-based study that reports the predictability of numerous personal attributes (349 binary variables) from 2646 distinct facial images of 969 individuals. Using deep learning, we find 82/349 personal attributes (23%) are predictable better than random from facial image pixels. Adding facial images substantially boosts prediction quality versus demographics-only benchmark model. Our unexpected finding of strong predictability of iPhone versus Galaxy preference variable shows how testing many hypotheses simultaneously can facilitate knowledge discovery. Our proposed L1-regularized image decomposition method and other techniques point to smartphone camera artifacts, BMI, skin properties, and facial hair as top candidate non-demographic signals in facial images.

A mixed-methods approach to understanding barriers and facilitators to healthy eating and exercise from five European countries: highlighting the roles of enjoyment, emotion and social engagement

Healthy adults are consistently falling below national and international recommendations for physical activity and dietary intake across Europe. This study took a co-creative approach with adult samples from five European countries to qualitatively and quantitatively establish motivators, barriers and sustaining factors for positive health behaviour change. Stage 1 delivered a newly-designed online programme, creating a community who identified challenges, motivators and solutions to sustaining positive healthy eating and physical activity behaviours. Stage 2 administered an online survey (developed from Stage 1 findings) to a larger sample to quantify the relative importance of these motivators and barriers. Results from both stages indicated enjoyment, positive emotions, and reward as key motivators for both behaviours across all five countries. Barriers included habit-breaking difficulties, temptation and negative affective states. Those with a high BMI placed more importance on social pressure than those with healthy BMI. Participants' reports of motivators and barriers reflected relevant approaches from consumer science, behavioural economics, and psychology. Interventions supporting adults who are not chronically ill but would benefit from improved diet and/or physical activity should not focus exclusively on health as a motivating factor. Emphasis on enjoyable behaviours, social engagement and reward will likely improve engagement and sustained behaviour change.

Crowdsourcing as a tool for creating effective nudges: An example for financial oversubscription

Creating effective nudges, or interventions that encourage people to make choices that increase their welfare, is difficult to execute well. Recent work on megastudies, massive field experiments that test many interventions simultaneously, reveals that nudge effectiveness both varies widely and is difficult for experts to predict. We propose an Iterative Crowdsourcing Procedure, which uses insights from members of the target population to generate and preselect nudges prior to testing them in a field experiment. This technique can supplement existing methods or stand alone as a way to generate conditions for testing in a high-quality field experiment. We test the effectiveness of this method in addressing a challenge to effective financial management: consumer oversubscription. We first document that people have more subscriptions than they think they have and that enhancing subscription awareness makes people want to cancel some subscriptions. We then use our crowdsourcing procedure to motivate people toward subscription awareness in a field experiment (N = 4,412,113) with a large bank. We find that the crowdsourced nudges outperform those generated by the bank, demonstrating that the Iterative Crowdsourcing Procedure is a useful way to generate effective nudges.

A Narrative Review of Non-Pharmacological Strategies for Managing Sarcopenia in Older Adults with Cardiovascular and Metabolic Diseases

This narrative review examines the mechanisms underlying the development of cardiovascular disease (CVD) and metabolic diseases (MDs), along with their association with sarcopenia. Furthermore, non-pharmacological interventions to address sarcopenia in patients with these conditions are suggested. The significance of combined training in managing metabolic disease and secondary sarcopenia in type II diabetes mellitus is emphasized. Additionally, the potential benefits of resistance and aerobic training are explored. This review emphasises the role of nutrition in addressing sarcopenia in patients with CVD or MDs, focusing on strategies such as optimising protein intake, promoting plant-based protein sources, incorporating antioxidant-rich foods and omega-3 fatty acids and ensuring sufficient vitamin D levels. Moreover, the potential benefits of targeting gut microbiota through probiotics and prebiotic fibres in sarcopenic individuals are considered. Multidisciplinary approaches that integrate behavioural science are explored to enhance the uptake and sustainability of behaviour-based sarcopenia interventions. Future research should prioritise high-quality randomized controlled trials to refine exercise and nutritional interventions and investigate the incorporation of behavioural science into routine practices. Ultimately, a comprehensive and multifaceted approach is essential to improve health outcomes, well-being and quality of life in older adults with sarcopenia and coexisting cardiovascular and metabolic diseases.

How to build up big team science: a practical guide for large-scale collaborations

The past decade has witnessed a proliferation of big team science (BTS), endeavours where a comparatively large number of researchers pool their intellectual and/or material resources in pursuit of a common goal. Despite this burgeoning interest, there exists little guidance on how to create, manage and participate in these collaborations. In this paper, we integrate insights from a multi-disciplinary set of BTS initiatives to provide a how-to guide for BTS. We first discuss initial considerations for launching a BTS project, such as building the team, identifying leadership, governance, tools and open science approaches. We then turn to issues related to running and completing a BTS project, such as study design, ethical approvals and issues related to data collection, management and analysis. Finally, we address topics that present special challenges for BTS, including authorship decisions, collaborative writing and team decision-making.

Why Should We Study the Foreign Language Effect: Debiasing through Affecting Metacognition?

Debiasing is a method of improving people's decisions by reducing their reliance on salient intuitions causing them to behave suboptimally or biasedly. However, many of the known debiasing techniques have limited effectiveness or can only remedy a one-shot decision, rather than having a lasting impact. In this work, I focus on the role of metacognition in debiasing decision-making and discuss how it can be better understood through the lens of the foreign language effect. The foreign language effect suggests that using a foreign language can sometimes benefit people's decision-making without providing them with additional information or instructions regarding the task. However, we do not fully understand how the foreign language effect works and its limitations. I conclude by urging scientists to research this effect with the hope of having a lasting positive impact on society.

Optimal outcomes from cardiac rehabilitation are associated with longer-term follow-up and risk factor status at 12 months: An observational registry-based study

AIM

The purpose of Cardiac Rehabilitation (CR) is to promote and reduce risk factors in the short and long term, however, the latter has, to date, been poorly evaluated. We explored characteristics associated with provision and outcomes of a long-term assessment in CR.

METHOD

Data from the UK National Audit of CR between April 2015 and March 2020 was used. Programmes were selected if they had an established mechanism and routine methodology to collect the 12-month assessments. Risk factors pre and post phase II CR and at the 12-month assessment were explored; BMI ≤30, ≥150 min of physical activity per week, hospital anxiety and depression scale (HADS) scores <8. The data came from 32 programmes, 24,644 patients with coronary heart disease. Patients being in at least one optimal risk factor stage throughout phase II CR (OR = 1.43 95% CI 1.28 to 1.59) or successfully reaching an optimal stage during phase II CR (OR = 1.61 95% CI 1.44 to 1.80) had an increased likelihood of being assessed at 12 months compared to those who did not. Patients being in the optimal stage upon completion of phase II CR had an increased likelihood of still being in the optimal stage at 12 months. Most prominent was BMI; (OR = 14.6 (95% CI 11.1 to 19.2) for patients reaching an optimal stage throughout phase II CR.

CONCLUSION

Being in an optimal stage upon routine CR completion could be an overlooked predictor in the provision of a long-term CR service and prediction of longer-term risk factor status.

What can machine learning teach us about habit formation? Evidence from exercise and hygiene

We apply a machine learning technique to characterize habit formation in two large panel data sets with objective measures of 1) gym attendance (over 12 million observations) and 2) hospital handwashing (over 40 million observations). Our Predicting Context Sensitivity (PCS) approach identifies context variables that best predict behavior for each individual. This approach also creates a time series of overall predictability for each individual. These time series predictability values are used to trace a habit formation curve for each individual, operationalizing the time of habit formation as the asymptotic limit of when behavior becomes highly predictable. Contrary to the popular belief in a "magic number" of days to develop a habit, we find that it typically takes months to form the habit of going to the gym but weeks to develop the habit of handwashing in the hospital. Furthermore, we find that gymgoers who are more predictable are less responsive to an intervention designed to promote more gym attendance, consistent with past experiments showing that habit formation generates insensitivity to reward devaluation.

Back Onside protocol: A physical activity intervention to improve health outcomes in people who are unemployed or at risk of unemployment

Given the effects of physical activity on people's mental and physical health, a better understanding is needed of how physical activity interventions may impact the health of people who are unemployed or at risk of unemployment. This has added urgency in the context of rising rates of poverty-related unemployment in the UK in 2022. The current paper details the protocol used in the evaluation of the Back Onside Programme; a community-based programme delivered by the Bradford Bulls Foundation in the Bradford District. The Programme supports people from low socio-economic backgrounds who are unemployed or at risk of unemployment to maintain regular physical activity through a ten-week physical activity intervention. This pilot study evaluates how a physical activity intervention may impact the mental and physical health of people who are unemployed or at risk of unemployment in an uncontrolled pragmatic pilot study. Four cohorts run back-to-back between May 2021 and May 2022, with separate groups for men (N = 100) and women (N = 60). Physical and wellbeing assessment at baseline and post-intervention is conducted. If the intervention works in this context for these individuals, it will be a promising low-cost community-based intervention for people who are unemployed or at risk of unemployment.

A Randomized Trial of Behavioral Nudges Delivered Through Text Messages to Increase Influenza Vaccination Among Patients With an Upcoming Primary Care Visit

PURPOSE

To evaluate if nudges delivered by text message prior to an upcoming primary care visit can increase influenza vaccination rates.

DESIGN

Randomized, controlled trial.

SETTING

Two health systems in the Northeastern US between September 2020 and March 2021.

SUBJECTS

74,811 adults.

INTERVENTIONS

Patients in the 19 intervention arms received 1-2 text messages in the 3 days preceding their appointment that varied in their format, interactivity, and content.

MEASURES

Influenza vaccination.

ANALYSIS

Intention-to-treat.

RESULTS

Participants had a mean (SD) age of 50.7 (16.2) years; 55.8% (41,771) were female, 70.6% (52,826) were White, and 19.0% (14,222) were Black. Among the interventions, 5 of 19 (26.3%) had a significantly greater vaccination rate than control. On average, the 19 interventions increased vaccination relative to control by 1.8 percentage points or 6.1% (P = .005). The top performing text message described the vaccine to the patient as "reserved for you" and led to a 3.1 percentage point increase (95% CI, 1.3 to 4.9; P < .001) in vaccination relative to control. Three of the top five performing messages described the vaccine as "reserved for you." None of the interventions performed worse than control.

CONCLUSIONS

Text messages encouraging vaccination and delivered prior to an upcoming appointment significantly increased influenza vaccination rates and could be a scalable approach to increase vaccination more broadly.

Interventions to Modify Psychological Well-Being: Progress, Promises, and an Agenda for Future Research

Psychological well-being, characterized by feelings, cognitions, and strategies that are associated with positive functioning (including hedonic and eudaimonic well-being), has been linked with better physical health and greater longevity. Importantly, psychological well-being can be strengthened with interventions, providing a strategy for improving population health. But are the effects of well-being interventions meaningful, durable, and scalable enough to improve health at a population-level? To assess this possibility, a cross-disciplinary group of scholars convened to review current knowledge and develop a research agenda. Here we summarize and build on the key insights from this convening, which were: (1) existing interventions should continue to be adapted to achieve a large-enough effect to result in downstream improvements in psychological functioning and health, (2) research should determine the durability of interventions needed to drive population-level and lasting changes, (3) a shift from individual-level care and treatment to a public-health model of population-level prevention is needed and will require new infrastructure that can deliver interventions at scale, (4) interventions should be accessible and effective in racially, ethnically, and geographically diverse samples. A discussion examining the key future research questions follows.

The Psychology of Athletic Endeavor

A considerable amount of human behavior occurs within the context of sports. In recent years there have been notable advances in psychological science research applied to understanding athletic endeavor. This work has utilized a number of novel theoretical, methodological, and data analytic approaches. We review the current evidence related to developmental considerations, intrapersonal athlete factors, group processes, and the role of the coach in explaining how athletes function within the sport domain. This body of work sheds light on the diverse ways in which psychological processes contribute to athletic strivings. It also has the potential to spark interest in domains of psychology concerned with achievement as well as to encourage cross-domain fertilization of ideas.

Lottery incentives for smoking cessation at the workplace: design and protocol of the smoke-free lottery - a cluster randomized trial

BACKGROUND

Smoking is the leading behavioral risk factor for the loss of healthy life years. Many smokers want to quit, but have trouble doing so. Financial incentives in workplace settings have shown promising results in supporting smokers and their design influences their impact. Lotteries that leverage behavioral economic insights might improve the effectiveness of workplace cessation support.

METHODS AND DESIGN

We examine in a cluster randomized trial if a workplace cessation group training paired with lottery deadlines will increase continuous abstinence rates over and above the cessation training alone. Organizations are randomized to either the control arm or lottery arm. The lotteries capitalize regret aversion by always informing winners at the deadline, but withholding prizes if they smoked. In the lottery-arm, winners are drawn out of all participants within a training group, regardless of their smoking status. In weeks 1-13 there are weekly lotteries. Winners are informed about their prize (€50), but can only claim it if they did not smoke that week, validated biochemically. After 26 weeks, there is a long-term lottery where the winners are informed about their prize (vacation voucher worth €400), but can only claim it if they were abstinent between weeks 13 and 26. The primary outcome is continuous abstinence 52 weeks after the quit date.

DISCUSSION

There is a quest for incentives to support smoking cessation that are considered fair, affordable and effective across different socioeconomic groups. Previous use of behavioral economics in the design of lotteries have shown promising results in changing health behavior. This cluster randomized trial aims to demonstrate if these lotteries are also effective for supporting smoking cessation. Therefore the study design and protocol are described in detail in this paper. Findings might contribute to the application and development of effective cessation support at the workplace.

TRIAL REGISTRATION

Netherlands Trial Register Identifier: NL8463 . Date of registration: 17-03-2020.

Megastudies: A New Approach to Reducing Vaccine Hesitation Worldwide

Vaccine hesitancy is a considerable obstacle to achieving vaccine protection worldwide. There needs to be more evidence-based research for interventions for vaccine hesitancy. Existing effectiveness evaluations are limited to one particular hypothesis, and no studies have compared the effectiveness of different interventions. A megastudy takes a large-scale, multi-intervention, uniform participant and the same evaluation criteria approach to evaluate many interventions simultaneously and find the most effective ones. Therefore, megastudies can help us find the most effective interventions for vaccine hesitancy. Additionally, considering the complex causes of vaccine hesitancy, we design interventions that involve social factors in megastudies. Lastly, quality control and justice are critical issues for megastudies in the future.

Genetic Pathways Underlying Individual Differences in Regular Physical Activity

Twin and family studies show a strong contribution of genetic factors to physical activity (PA) assessed by either self-report or accelerometers. PA heritability is around 43% across the lifespan. Genome-wide association studies have implied biological pathways related to exercise ability and enjoyment. A polygenic score based on genetic variants influencing PA could help improve the success of intervention programs.

Financial incentives for vaccination do not have negative unintended consequences

Financial incentives to encourage healthy and prosocial behaviours often trigger initial behavioural change1-11, but a large academic literature warns against using them12-16. Critics warn that financial incentives can crowd out prosocial motivations and reduce perceived safety and trust, thereby reducing healthy behaviours when no payments are offered and eroding morals more generally17-24. Here we report findings from a large-scale, pre-registered study in Sweden that causally measures the unintended consequences of offering financial incentives for taking the first dose of a COVID-19 vaccine. We use a unique combination of random exposure to financial incentives, population-wide administrative vaccination records and rich survey data. We find no negative consequences of financial incentives; we can reject even small negative impacts of offering financial incentives on future vaccination uptake, morals, trust and perceived safety. In a complementary study, we find that informing US residents about the existence of state incentive programmes also has no negative consequences. Our findings inform not only the academic debate on financial incentives for behaviour change but also policy-makers who consider using financial incentives to change behaviour.

An Overview of Innovative Approaches to Support Timely and Agile Health Communication Research and Practice

Innovative approaches are needed to make health communication research and practice more timely, responsive, and effective in a rapidly changing information ecosystem. In this paper we provide an overview of strategies that can enhance the delivery and effectiveness of health communication campaigns and interventions, as well as research approaches that can generate useful data and insights for decisionmakers and campaign designers, thereby reducing the research-to-practice gap. The discussion focuses on the following approaches: digital segmentation and microtargeting, social media influencer campaigns, recommender systems, adaptive interventions, A/B testing, efficient message testing protocols, rapid cycle iterative message testing, megastudies, and agent-based modeling. For each method highlighted, we also outline important practical and ethical considerations for utilizing the approach in the context of health communication research and practice, including issues related to transparency, privacy, equity, and potential for harm.

A guide to megastudies

How can behavioral insights best be leveraged to solve pressing policy challenges? Because research studies are typically designed to test the validity of a particular idea, surprisingly little is known about the relative efficacy of different approaches to changing behavior in any given policy context. We discuss megastudies as a research approach that can surmount this and other obstacles to developing optimal behaviorally informed policy interventions. We define a megastudy as "a massive field experiment in which many different treatments are tested synchronously in one large sample using a common, objectively measured outcome." We summarize this apples-to-apples approach to research and lay out recommendations, limitations, and promising future directions for scholars who might want to conduct or evaluate megastudies.

Crowdsourcing interventions to promote uptake of COVID-19 booster vaccines

BACKGROUND

COVID-19 booster vaccine uptake rates are behind the rate of primary vaccination in many countries. Governments and non-governmental institutions rely on a range of interventions aiming to increase booster uptake. Yet, little is known how experts and the general public evaluate these interventions.

METHODS

We applied a novel crowdsourcing approach to provide rapid insights on the most promising interventions to promote uptake of COVID-19 booster vaccines. In the first phase (December 2021), international experts (n = 78 from 17 countries) proposed 46 unique interventions. To reduce noise and potential bias, in the second phase (January 2022), experts (n = 307 from 34 countries) and representative general population samples from the UK (n = 299) and the US (n = 300) rated the proposed interventions on several evaluation criteria, including effectiveness and acceptability, on a 5-point Likert-type scale.

FINDINGS

Sanctions were evaluated as potentially most effective but least accepted. Evaluations by expert and general population samples were considerably aligned. Interventions that received the most positive evaluations regarding both effectiveness and acceptability across evaluation groups were: a day off work after getting vaccinated, financial incentives, tax benefits, promotional campaigns, and mobile vaccination teams.

INTERPRETATION

The results provide useful insights to help governmental and non-governmental institutions in their decisions about which interventions to implement. Additionally, the applied crowdsourcing method may be used in future studies to retrieve rapid insights on the comparative evaluation of (health) policies.

FUNDING

This study received funding from the Austrian Science Fund (SFB F63) and the University of Vienna.

Role of Psychologists in Pediatric Sleep Medicine

Sleep disorders commonly afflict infants, children, and adolescents and have a significant adverse impact on them and their families, sometimes to a severe degree. They can cause immediate stress and suffering and long-term loss of opportunities and potential. Many of these disorders can be well managed by the psychologist and often one is required, either as the sole provider or as an integral part of a team. Sleep disorders have a bidirectional interplay with mental health disorders. The patient may therefore present initially to the psychologist, primary care provider, or the sleep medicine specialist.

Barriers and Facilitators to Participating in an Exercise Referral Scheme among Women Living in a Low Socioeconomic Area in Australia: A Qualitative Investigation Using the COM-B and Theoretical Domains Framework

INTRODUCTION

Despite the health benefits of regular physical activity, women experiencing socioeconomic disadvantage are at high risk of inactivity. Reasons are multifactorial but likely include broad structural and contextual factors, e.g., lack of access to physical activity programs, as well as individual and interpersonal factors, e.g., lack of motivation and childcaring responsibilities. Few studies among women of low socioeconomic position (SEP) have explored these factors in-depth, yet an understanding of these factors can help inform the development and improve the uptake of exercise referral schemes. The Theoretical Domains Framework (TDF) and COM-B model (capability, opportunity, motivation and behaviour) were employed to understand behaviours for intervention development. Therefore, using these behaviour change models, this study aimed to explore the barriers and facilitators influencing the use of an exercise referral scheme among women living in a socioeconomically disadvantaged area.

METHODS

Semi-structured interviews were conducted with women who had registered with a free exercise referral scheme (Live Life Get Active) and living in a low socioeconomic neighbourhood in Sydney, Australia. Reflexive thematic analysis and framework analysis were used to allow naturally identified themes to be determined and then allocated to theoretically driven domains.

RESULTS

Nine women were interviewed (aged 30-69 years). Eighteen themes were identified and mapped directly on to the six COM-B constructs. The most reported barriers to using the physical activity referral scheme related to the opportunity construct of the COM-B model, specifically childcare responsibilities, work commitments and environmental barriers. Key facilitators were enjoyment (motivation), no cost (opportunity), instructor led (opportunity) and social support (opportunity).

CONCLUSION

Future exercise referral schemes targeting women living in low-SEP neighbourhoods should ensure programs are designed and delivered to overcome barriers aligned with the constructs of the COM-B model, particularly opportunity-related constructors.

Effects of side-effect risk framing strategies on COVID-19 vaccine intentions: a randomized controlled trial

Background:

Fear over side-effects is one of the main drivers of COVID-19 vaccine hesitancy. A large literature in the behavioral and communication sciences finds that how risks are framed and presented to individuals affects their judgments of its severity. However, it remains unknown whether such framing changes can affect COVID-19 vaccine behavior and be deployed as policy solutions to reduce hesitancy.

Methods:

We conducted a pre-registered randomized controlled trial among 8998 participants in the United States and the United Kingdom to examine the effects of different ways of framing and presenting vaccine side-effects on individuals’ willingness to get vaccinated and their perceptions of vaccine safety.

Results:

Adding a descriptive risk label (‘very low risk’) next to the numerical side-effect and providing a comparison to motor-vehicle mortality increased participants’ willingness to take the COVID-19 vaccine by 3.0 percentage points (p=0.003) and 2.4 percentage points (p=0.049), respectively. These effects were independent and additive and combining both framing strategies increased willingness to receive the vaccine by 6.1 percentage points (p<0.001). Mechanistically, we find evidence that these framing effects operate by increasing individuals’ perceptions of how safe the vaccine is.

Conclusions:

Low-cost side-effect framing strategies can meaningfully affect vaccine intentions at a population level.

Funding:

Heidelberg Institute of Global Health.

Clinical trial number:

German Clinical Trials Registry (#DRKS00025551).

Vaccination is one of the main strategies for controlling the COVID-19 pandemic. But vaccination rates have slowed and are below target levels in countries like the United States and the United Kingdom. While there are many causes of vaccine hesitancy, several studies have found that fear of side effects is the one of the most important.

Although COVID-19 vaccine side-effects are rare, how the media presents these risks may amplify concerns. Addressing public concerns over vaccine side effects is key to improving the uptake of vaccines and booster doses, which has been even lower than primary vaccine series uptake.

Studies show that how risk is presented affects people’s risk perceptions and behavior. To learn more about how COVID-19 vaccine risk framing affects risk perception, Sudharsanan et al. enrolled 8,998 people from the United States and the United Kingdom in an online randomized controlled trial. Participants received information about a hypothetical new COVID-19 vaccine, including its side effect rate, and reported their perception of safety and whether they would take the vaccine.

The experiments showed that adding the label “very low risk” when describing vaccine side effect rates increased the number of people who said they would take the vaccine by three percentage points. Comparing the risks of the hypothetical vaccine to the much higher chances of motor vehicle deaths increased an individual’s willingness to take the vaccine by 2.4 percentage points. Combining both framing strategies increased people’s desire to get vaccinated by 6.1 percentage points.

Deploying these two strategies in vaccine risk communications may help increase primary and booster vaccinations against COVID-19. A next step would be to measure both vaccination intentions and vaccination rates to confirm these strategies.

Computational mechanisms for context-based behavioral interventions: A large-scale analysis

A large body of research in the social and behavioral sciences studies the impact of behavioral interventions (or “nudges”) on decisions. Although this work has been extremely influential, we currently lack an overarching theoretical framework for behavioral interventions that provides a systematic account of their behavioral consequences, cognitive and neurobiological mechanisms, and statistical interpretations. In this paper, we propose such a theoretical framework using the diffusion decision model, a quantitative theory of decision-making whose parameters offer a theoretically compelling characterization of choice underpinnings. Our results not only reveal insights about how context-based interventions alter behavior but also offer practitioners a model-based method for choosing between behavioral interventions based on different goals.

Choice context influences decision processes and is one of the primary determinants of what people choose. This insight has been used by academics and practitioners to study decision biases and to design behavioral interventions to influence and improve choices. We analyzed the effects of context-based behavioral interventions on the computational mechanisms underlying decision-making. We collected data from two large laboratory studies involving 19 prominent behavioral interventions, and we modeled the influence of each intervention using a leading computational model of choice in psychology and neuroscience. This allowed us to parametrize the biases induced by each intervention, to interpret these biases in terms of underlying decision mechanisms and their properties, to quantify similarities between interventions, and to predict how different interventions alter key choice outcomes. In doing so, we offer researchers and practitioners a theoretically principled approach to understanding and manipulating choice context in decision-making.

Effectiveness of eHealth Interventions Targeting Employee Health Behaviors: Systematic Review (Preprint)

BACKGROUND

The number of people with noncommunicable diseases is increasing. Noncommunicable diseases are the major cause of disability and premature mortality worldwide, associated with negative workplace outcomes such as sickness absence and reduced work productivity. There is a need to identify scalable interventions and their active components to relieve disease and treatment burden and facilitate work participation. eHealth interventions have shown potential in clinical and general populations to increase well-being and physical activity and could be well suited for workplace settings.

OBJECTIVE

We aimed to provide an overview of the effectiveness of eHealth interventions at the workplace targeting employee health behaviors and map behavior change techniques (BCTs) used in these interventions.

METHODS

A systematic literature search was performed in PubMed, Embase, PsycINFO, Cochrane CENTRAL, and CINAHL in September 2020 and updated in September 2021. Extracted data included participant characteristics, setting, eHealth intervention type, mode of delivery, reported outcomes, effect sizes, and attrition rates. Quality and risk of bias of the included studies were assessed using the Cochrane Collaboration risk-of-bias 2 tool. BCTs were mapped in accordance with the BCT Taxonomy v1. The review was reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist.

RESULTS

In total, 17 randomized controlled trials met the inclusion criteria. The measured outcomes, treatment and follow-up periods, content of eHealth interventions, and workplace contexts had high heterogeneity. Of the 17 studies, 4 (24%) reported unequivocally significant findings for all primary outcomes, with effect sizes ranging from small to large. Furthermore, 53% (9/17) of the studies reported mixed results, and 24% (4/17) reported nonsignificant results. The most frequently targeted behavior was physical activity (15/17, 88% of the studies); the least frequently targeted behavior was smoking (2/17, 12% of the studies). Attrition varied greatly across the studies (0%-37%). Risk of bias was high in 65% (11/17) of the studies, with some concerns in the remaining 35% (6/17). Interventions used various BCTs, and the most frequently used were feedback and monitoring (14/17, 82%), goals and planning (10/17, 59%), antecedents (10/17, 59%), and social support (7/17, 41%).

CONCLUSIONS

This review suggests that, although eHealth interventions may have potential, there are still unanswered questions regarding their effectiveness and what drives the mechanism behind these effects. Low methodological quality, high heterogeneity and complexity, the characteristics of the included samples, and often high attrition rates challenge the investigation of the effectiveness and the making of sound inferences about the effect sizes and significance of the results. To address this, new studies and methods are needed. A megastudy design in which different interventions are evaluated in the same population over the same period on the same outcomes may solve some of the challenges.

TRIAL REGISTRATION

PROSPERO CRD42020202777; https://www-crd-york-ac-uk/prospero/display_record.php?RecordID=202777.

A 680,000-person megastudy of nudges to encourage vaccination in pharmacies

Encouraging vaccination is a pressing policy problem. To assess whether text-based reminders can encourage pharmacy vaccination and what kinds of messages work best, we conducted a megastudy. We randomly assigned 689,693 Walmart pharmacy patients to receive one of 22 different text reminders using a variety of different behavioral science principles to nudge flu vaccination or to a business-as-usual control condition that received no messages. We found that the reminder texts that we tested increased pharmacy vaccination rates by an average of 2.0 percentage points, or 6.8%, over a 3-mo follow-up period. The most-effective messages reminded patients that a flu shot was waiting for them and delivered reminders on multiple days. The top-performing intervention included two texts delivered 3 d apart and communicated to patients that a vaccine was "waiting for you." Neither experts nor lay people anticipated that this would be the best-performing treatment, underscoring the value of simultaneously testing many different nudges in a highly powered megastudy.

Ten ignored questions for stress psychology research

Stress psychology is an interesting and important interdisciplinary research field. In this perspective article, we briefly discuss 10 challenges related to the conceptual definition, research methodology, and translation in the field of stress that do not receive sufficient attention or are ignored entirely. Future research should attempt to integrate a comprehensive stress conceptual framework into a multidimensional comprehensive stress model, incorporating subjective and objective indicators as comprehensive measures. The popularity of machine learning, cognitive neuroscience, and gene epigenetics is a promising approach that brings innovation to the field of stress psychology. The development of wearable devices that precisely record physiological signals to assess stress responses in naturalistic situations, standardize real-life stressors, and measure baselines presents challenges to address in the future. Conducting large individualized and digital intervention studies could be crucial steps in enhancing the translation of research.

Tutorial. A Behavioral Analysis of Rationality, Nudging, and Boosting: Implications for Policymaking

As recent trends in policymaking call for increased contributions from behavioral science, nudging and boosting represent two effective and relatively economic approaches for influencing choice behavior. They utilize concepts from behavioral economics to affect agents’ concurrent suboptimal choices: in principle, without applying coercion. However, most choice situations involve some coercive elements. This study features a functional analysis of rationality, nudging, and boosting applied to public policy. The relationship between behavior and environmental variables is termed a “behavioral contingency,” and the analysis can include social and cultural phenomena by applying a selectionist perspective. Principles of behavioral control, whether tight or loose, may be exerted by policymakers or regulators who subscribe to paternalistic principles and may be met with demands of libertarianism among their recipients. This warrants discussion of the legitimacy and likelihood of behavioral control and influence on choices. Cases and examples are provided for extending the unit of analysis of choice behavior to achieve outcomes regulated by policies at the individual and group levels, including health, climate, and education. Further research and intervention comprise the study of macrocontingencies and metacontingencies. Advancing the understanding and application of behavioral science to policymaking may, therefore, benefit from moving from the relatively independent contributions of behavioral economics and behavior analysis to an inclusive selectionist approach for addressing choice behavior and cultural practices.